Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC THERASKIN PER SQ CM (6 SQ CM)

Facility

$412.78

Service Code	HCPCS Q4121
Hospital Charge Code	63600127
Hospital Revenue Code	636
Min. Negotiated Rate	$260.05
Max. Negotiated Rate	$371.50
Rate for Payer: Aetna Commercial	$350.86
Rate for Payer: Aetna New Business (MI Preferred)	$268.31
Rate for Payer: Cash Price	$330.22
Rate for Payer: Cofinity Commercial	$288.95
Rate for Payer: Cofinity Commercial	$354.99
Rate for Payer: Healthscope Commercial	$371.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$350.86
Rate for Payer: PHP Commercial	$350.86
Rate for Payer: Priority Health Cigna Priority Health	$288.95
Rate for Payer: Priority Health SBD	$260.05

HC THERASKIN PER SQ CM (6 SQ CM)

Facility

$412.78

Service Code	HCPCS Q4121
Hospital Charge Code	63600127
Hospital Revenue Code	636
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$371.50
Rate for Payer: Aetna Commercial	$350.86
Rate for Payer: Aetna New Business (MI Preferred)	$268.31
Rate for Payer: BCBS Complete	$165.11
Rate for Payer: BCBS Trust/PPO	$21.70
Rate for Payer: Cash Price	$330.22
Rate for Payer: Cash Price	$330.22
Rate for Payer: Cofinity Commercial	$354.99
Rate for Payer: Cofinity Commercial	$288.95
Rate for Payer: Healthscope Commercial	$371.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$350.86
Rate for Payer: PHP Commercial	$350.86
Rate for Payer: Priority Health Cigna Priority Health	$288.95
Rate for Payer: Priority Health SBD	$260.05

HC THER PROC STRGTH/END RESP 15M

Facility

$85.96

Service Code	HCPCS G0237
Hospital Charge Code	41000047
Hospital Revenue Code	410
Min. Negotiated Rate	$54.15
Max. Negotiated Rate	$77.36
Rate for Payer: Aetna Commercial	$73.07
Rate for Payer: Aetna New Business (MI Preferred)	$55.87
Rate for Payer: Cash Price	$68.77
Rate for Payer: Cofinity Commercial	$60.17
Rate for Payer: Cofinity Commercial	$73.93
Rate for Payer: Healthscope Commercial	$77.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$73.07
Rate for Payer: PHP Commercial	$73.07
Rate for Payer: Priority Health Cigna Priority Health	$60.17
Rate for Payer: Priority Health SBD	$54.15

HC THER PROC STRGTH/END RESP 15M

Facility

$85.96

Service Code	HCPCS G0237
Hospital Charge Code	41000047
Hospital Revenue Code	410
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$77.36
Rate for Payer: Aetna Commercial	$73.07
Rate for Payer: Aetna Medicare	$27.55
Rate for Payer: Aetna New Business (MI Preferred)	$55.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$33.11
Rate for Payer: Amish Plain Church Group Commercial	$33.11
Rate for Payer: BCBS Complete	$15.22
Rate for Payer: BCBS MAPPO	$26.49
Rate for Payer: BCBS Trust/PPO	$10.71
Rate for Payer: BCN Medicare Advantage	$26.49
Rate for Payer: Cash Price	$68.77
Rate for Payer: Cash Price	$68.77
Rate for Payer: Cofinity Commercial	$73.93
Rate for Payer: Cofinity Commercial	$60.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$26.49
Rate for Payer: Healthscope Commercial	$77.36
Rate for Payer: Mclaren Medicaid	$14.49
Rate for Payer: Mclaren Medicare	$26.49
Rate for Payer: Meridian Medicaid	$15.22
Rate for Payer: Meridian Wellcare - Medicare Advantage	$27.81
Rate for Payer: MI Amish Medical Board Commercial	$30.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$73.07
Rate for Payer: PACE Medicare	$25.17
Rate for Payer: PACE SWMI	$26.49
Rate for Payer: PHP Commercial	$73.07
Rate for Payer: PHP Medicare Advantage	$26.49
Rate for Payer: Priority Health Choice Medicaid	$14.49
Rate for Payer: Priority Health Cigna Priority Health	$60.17
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$74.83
Rate for Payer: Priority Health Medicare	$26.49
Rate for Payer: Priority Health Narrow Network	$59.86
Rate for Payer: Priority Health SBD	$54.15
Rate for Payer: Railroad Medicare Medicare	$26.49
Rate for Payer: UHC All Payor (Choice/PPO)	$12.24
Rate for Payer: UHC Dual Complete DSNP	$26.49
Rate for Payer: UHC Exchange	$11.13
Rate for Payer: UHC Medicare Advantage	$27.28
Rate for Payer: VA VA	$26.49

HC THIAMINE LEVEL VITAMIN B1

Facility

$60.18

Service Code	CPT 84425
Hospital Charge Code	30100432
Hospital Revenue Code	301
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$54.16
Rate for Payer: Aetna Commercial	$51.15
Rate for Payer: Aetna Medicare	$22.08
Rate for Payer: Aetna New Business (MI Preferred)	$39.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$26.54
Rate for Payer: Amish Plain Church Group Commercial	$26.54
Rate for Payer: BCBS Complete	$12.19
Rate for Payer: BCBS MAPPO	$21.23
Rate for Payer: BCBS Trust/PPO	$16.62
Rate for Payer: BCN Medicare Advantage	$21.23
Rate for Payer: Cash Price	$48.14
Rate for Payer: Cash Price	$48.14
Rate for Payer: Cofinity Commercial	$51.75
Rate for Payer: Cofinity Commercial	$42.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$21.23
Rate for Payer: Healthscope Commercial	$54.16
Rate for Payer: Mclaren Medicaid	$11.61
Rate for Payer: Mclaren Medicare	$21.23
Rate for Payer: Meridian Medicaid	$12.19
Rate for Payer: Meridian Wellcare - Medicare Advantage	$22.29
Rate for Payer: MI Amish Medical Board Commercial	$24.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.15
Rate for Payer: PACE Medicare	$20.17
Rate for Payer: PACE SWMI	$21.23
Rate for Payer: PHP Commercial	$51.15
Rate for Payer: PHP Medicare Advantage	$21.23
Rate for Payer: Priority Health Choice Medicaid	$11.61
Rate for Payer: Priority Health Cigna Priority Health	$42.13
Rate for Payer: Priority Health Medicare	$21.23
Rate for Payer: Priority Health SBD	$37.91
Rate for Payer: Railroad Medicare Medicare	$21.23
Rate for Payer: UHC All Payor (Choice/PPO)	$25.48
Rate for Payer: UHC Core	$36.08
Rate for Payer: UHC Dual Complete DSNP	$21.23
Rate for Payer: UHC Exchange	$21.23
Rate for Payer: UHC Medicare Advantage	$21.87
Rate for Payer: VA VA	$21.23

HC THIAMINE LEVEL VITAMIN B1

Facility

$60.18

Service Code	CPT 84425
Hospital Charge Code	30100432
Hospital Revenue Code	301
Min. Negotiated Rate	$37.91
Max. Negotiated Rate	$54.16
Rate for Payer: Aetna Commercial	$51.15
Rate for Payer: Aetna New Business (MI Preferred)	$39.12
Rate for Payer: Cash Price	$48.14
Rate for Payer: Cofinity Commercial	$42.13
Rate for Payer: Cofinity Commercial	$51.75
Rate for Payer: Healthscope Commercial	$54.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.15
Rate for Payer: PHP Commercial	$51.15
Rate for Payer: Priority Health Cigna Priority Health	$42.13
Rate for Payer: Priority Health SBD	$37.91

HC THIN PREP PAP DIAGNOSTIC

Facility

$76.50

Service Code	CPT 88142
Hospital Charge Code	31100004
Hospital Revenue Code	311
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$68.85
Rate for Payer: Aetna Commercial	$65.02
Rate for Payer: Aetna Medicare	$21.07
Rate for Payer: Aetna New Business (MI Preferred)	$49.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$25.32
Rate for Payer: Amish Plain Church Group Commercial	$25.32
Rate for Payer: BCBS Complete	$11.64
Rate for Payer: BCBS MAPPO	$20.26
Rate for Payer: BCBS Trust/PPO	$15.87
Rate for Payer: BCCCP Commercial	$20.26
Rate for Payer: BCN Medicare Advantage	$20.26
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$53.55
Rate for Payer: Cofinity Commercial	$65.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$20.26
Rate for Payer: Healthscope Commercial	$68.85
Rate for Payer: Mclaren Medicaid	$11.08
Rate for Payer: Mclaren Medicare	$20.26
Rate for Payer: Meridian Medicaid	$11.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$21.27
Rate for Payer: MI Amish Medical Board Commercial	$23.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: PACE Medicare	$19.25
Rate for Payer: PACE SWMI	$20.26
Rate for Payer: PHP Commercial	$65.02
Rate for Payer: PHP Medicare Advantage	$20.26
Rate for Payer: Priority Health Choice Medicaid	$11.08
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: Priority Health Medicare	$20.26
Rate for Payer: Priority Health SBD	$48.20
Rate for Payer: Railroad Medicare Medicare	$20.26
Rate for Payer: UHC All Payor (Choice/PPO)	$24.31
Rate for Payer: UHC Core	$34.44
Rate for Payer: UHC Dual Complete DSNP	$20.26
Rate for Payer: UHC Exchange	$20.26
Rate for Payer: UHC Medicare Advantage	$20.87
Rate for Payer: VA VA	$20.26

HC THIN PREP PAP DIAGNOSTIC

Facility

$76.50

Service Code	CPT 88142
Hospital Charge Code	31100004
Hospital Revenue Code	311
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$68.85
Rate for Payer: Aetna Commercial	$65.02
Rate for Payer: Aetna New Business (MI Preferred)	$49.72
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$53.55
Rate for Payer: Cofinity Commercial	$65.79
Rate for Payer: Healthscope Commercial	$68.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: PHP Commercial	$65.02
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: Priority Health SBD	$48.20

HC THIN PREP PAP DIAGNOSTIC AUTO

Facility

$76.50

Service Code	CPT 88175
Hospital Charge Code	31100031
Hospital Revenue Code	311
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$68.85
Rate for Payer: Aetna Commercial	$65.02
Rate for Payer: Aetna New Business (MI Preferred)	$49.72
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$53.55
Rate for Payer: Cofinity Commercial	$65.79
Rate for Payer: Healthscope Commercial	$68.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: PHP Commercial	$65.02
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: Priority Health SBD	$48.20

HC THIN PREP PAP DIAGNOSTIC AUTO

Facility

$76.50

Service Code	CPT 88175
Hospital Charge Code	31100031
Hospital Revenue Code	311
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$68.85
Rate for Payer: Aetna Commercial	$65.02
Rate for Payer: Aetna Medicare	$27.67
Rate for Payer: Aetna New Business (MI Preferred)	$49.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$33.26
Rate for Payer: Amish Plain Church Group Commercial	$33.26
Rate for Payer: BCBS Complete	$15.28
Rate for Payer: BCBS MAPPO	$26.61
Rate for Payer: BCBS Trust/PPO	$20.84
Rate for Payer: BCCCP Commercial	$26.49
Rate for Payer: BCN Medicare Advantage	$26.61
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$53.55
Rate for Payer: Cofinity Commercial	$65.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$26.61
Rate for Payer: Healthscope Commercial	$68.85
Rate for Payer: Mclaren Medicaid	$14.56
Rate for Payer: Mclaren Medicare	$26.61
Rate for Payer: Meridian Medicaid	$15.28
Rate for Payer: Meridian Wellcare - Medicare Advantage	$27.94
Rate for Payer: MI Amish Medical Board Commercial	$30.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: PACE Medicare	$25.28
Rate for Payer: PACE SWMI	$26.61
Rate for Payer: PHP Commercial	$65.02
Rate for Payer: PHP Medicare Advantage	$26.61
Rate for Payer: Priority Health Choice Medicaid	$14.56
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: Priority Health Medicare	$26.61
Rate for Payer: Priority Health SBD	$48.20
Rate for Payer: Railroad Medicare Medicare	$26.61
Rate for Payer: UHC All Payor (Choice/PPO)	$31.93
Rate for Payer: UHC Core	$45.02
Rate for Payer: UHC Dual Complete DSNP	$26.61
Rate for Payer: UHC Exchange	$26.61
Rate for Payer: UHC Medicare Advantage	$27.41
Rate for Payer: VA VA	$26.61

HC THIN PREP PAP SCREENING

Facility

$76.50

Service Code	HCPCS G0123
Hospital Charge Code	31100028
Hospital Revenue Code	311
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$68.85
Rate for Payer: Aetna Commercial	$65.02
Rate for Payer: Aetna Medicare	$21.07
Rate for Payer: Aetna New Business (MI Preferred)	$49.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$25.32
Rate for Payer: Amish Plain Church Group Commercial	$25.32
Rate for Payer: BCBS Complete	$11.64
Rate for Payer: BCBS MAPPO	$20.26
Rate for Payer: BCBS Trust/PPO	$15.87
Rate for Payer: BCCCP Commercial	$20.26
Rate for Payer: BCN Medicare Advantage	$20.26
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$53.55
Rate for Payer: Cofinity Commercial	$65.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$20.26
Rate for Payer: Healthscope Commercial	$68.85
Rate for Payer: Mclaren Medicaid	$11.08
Rate for Payer: Mclaren Medicare	$20.26
Rate for Payer: Meridian Medicaid	$11.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$21.27
Rate for Payer: MI Amish Medical Board Commercial	$23.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: PACE Medicare	$19.25
Rate for Payer: PACE SWMI	$20.26
Rate for Payer: PHP Commercial	$65.02
Rate for Payer: PHP Medicare Advantage	$20.26
Rate for Payer: Priority Health Choice Medicaid	$11.08
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: Priority Health Medicare	$20.26
Rate for Payer: Priority Health SBD	$48.20
Rate for Payer: Railroad Medicare Medicare	$20.26
Rate for Payer: UHC All Payor (Choice/PPO)	$24.31
Rate for Payer: UHC Core	$34.44
Rate for Payer: UHC Dual Complete DSNP	$20.26
Rate for Payer: UHC Exchange	$20.26
Rate for Payer: UHC Medicare Advantage	$20.87
Rate for Payer: VA VA	$20.26

HC THIN PREP PAP SCREENING

Facility

$76.50

Service Code	HCPCS G0123
Hospital Charge Code	31100028
Hospital Revenue Code	311
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$68.85
Rate for Payer: Aetna Commercial	$65.02
Rate for Payer: Aetna New Business (MI Preferred)	$49.72
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$53.55
Rate for Payer: Cofinity Commercial	$65.79
Rate for Payer: Healthscope Commercial	$68.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: PHP Commercial	$65.02
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: Priority Health SBD	$48.20

HC THIN PREP PAP SCREENING AUTO

Facility

$76.50

Service Code	HCPCS G0145
Hospital Charge Code	31100032
Hospital Revenue Code	311
Min. Negotiated Rate	$14.49
Max. Negotiated Rate	$68.85
Rate for Payer: Aetna Commercial	$65.02
Rate for Payer: Aetna Medicare	$27.55
Rate for Payer: Aetna New Business (MI Preferred)	$49.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$33.11
Rate for Payer: Amish Plain Church Group Commercial	$33.11
Rate for Payer: BCBS Complete	$15.22
Rate for Payer: BCBS MAPPO	$26.49
Rate for Payer: BCBS Trust/PPO	$20.75
Rate for Payer: BCCCP Commercial	$26.49
Rate for Payer: BCN Medicare Advantage	$26.49
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$53.55
Rate for Payer: Cofinity Commercial	$65.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$26.49
Rate for Payer: Healthscope Commercial	$68.85
Rate for Payer: Mclaren Medicaid	$14.49
Rate for Payer: Mclaren Medicare	$26.49
Rate for Payer: Meridian Medicaid	$15.22
Rate for Payer: Meridian Wellcare - Medicare Advantage	$27.81
Rate for Payer: MI Amish Medical Board Commercial	$30.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: PACE Medicare	$25.17
Rate for Payer: PACE SWMI	$26.49
Rate for Payer: PHP Commercial	$65.02
Rate for Payer: PHP Medicare Advantage	$26.49
Rate for Payer: Priority Health Choice Medicaid	$14.49
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: Priority Health Medicare	$26.49
Rate for Payer: Priority Health SBD	$48.20
Rate for Payer: Railroad Medicare Medicare	$26.49
Rate for Payer: UHC All Payor (Choice/PPO)	$31.79
Rate for Payer: UHC Core	$45.02
Rate for Payer: UHC Dual Complete DSNP	$26.49
Rate for Payer: UHC Exchange	$26.49
Rate for Payer: UHC Medicare Advantage	$27.28
Rate for Payer: VA VA	$26.49

HC THIN PREP PAP SCREENING AUTO

Facility

$76.50

Service Code	HCPCS G0145
Hospital Charge Code	31100032
Hospital Revenue Code	311
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$68.85
Rate for Payer: Aetna Commercial	$65.02
Rate for Payer: Aetna New Business (MI Preferred)	$49.72
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cofinity Commercial	$53.55
Rate for Payer: Cofinity Commercial	$65.79
Rate for Payer: Healthscope Commercial	$68.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.02
Rate for Payer: PHP Commercial	$65.02
Rate for Payer: Priority Health Cigna Priority Health	$53.55
Rate for Payer: Priority Health SBD	$48.20

HC THIOPURINE METABOLITES

Facility

$290.00

Service Code	CPT 80299
Hospital Charge Code	30100719
Hospital Revenue Code	301
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna Commercial	$246.50
Rate for Payer: Aetna Medicare	$19.39
Rate for Payer: Aetna New Business (MI Preferred)	$188.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$23.30
Rate for Payer: Amish Plain Church Group Commercial	$23.30
Rate for Payer: BCBS Complete	$10.71
Rate for Payer: BCBS MAPPO	$18.64
Rate for Payer: BCBS Trust/PPO	$14.60
Rate for Payer: BCN Medicare Advantage	$18.64
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cofinity Commercial	$249.40
Rate for Payer: Cofinity Commercial	$203.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$18.64
Rate for Payer: Healthscope Commercial	$261.00
Rate for Payer: Mclaren Medicaid	$10.20
Rate for Payer: Mclaren Medicare	$18.64
Rate for Payer: Meridian Medicaid	$10.71
Rate for Payer: Meridian Wellcare - Medicare Advantage	$19.57
Rate for Payer: MI Amish Medical Board Commercial	$21.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$246.50
Rate for Payer: PACE Medicare	$17.71
Rate for Payer: PACE SWMI	$18.64
Rate for Payer: PHP Commercial	$246.50
Rate for Payer: PHP Medicare Advantage	$18.64
Rate for Payer: Priority Health Choice Medicaid	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$203.00
Rate for Payer: Priority Health Medicare	$18.64
Rate for Payer: Priority Health SBD	$182.70
Rate for Payer: Railroad Medicare Medicare	$18.64
Rate for Payer: UHC All Payor (Choice/PPO)	$22.37
Rate for Payer: UHC Core	$23.28
Rate for Payer: UHC Dual Complete DSNP	$18.64
Rate for Payer: UHC Exchange	$18.64
Rate for Payer: UHC Medicare Advantage	$19.20
Rate for Payer: VA VA	$18.64

HC THIOPURINE METABOLITES

Facility

$290.00

Service Code	CPT 80299
Hospital Charge Code	30100719
Hospital Revenue Code	301
Min. Negotiated Rate	$182.70
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna Commercial	$246.50
Rate for Payer: Aetna New Business (MI Preferred)	$188.50
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cofinity Commercial	$203.00
Rate for Payer: Cofinity Commercial	$249.40
Rate for Payer: Healthscope Commercial	$261.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$246.50
Rate for Payer: PHP Commercial	$246.50
Rate for Payer: Priority Health Cigna Priority Health	$203.00
Rate for Payer: Priority Health SBD	$182.70

HC THIOPURINE METHYLTRANSFERASE RBC

Facility

$324.00

Service Code	CPT 82657
Hospital Charge Code	30100621
Hospital Revenue Code	301
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna Commercial	$275.40
Rate for Payer: Aetna Medicare	$23.06
Rate for Payer: Aetna New Business (MI Preferred)	$210.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$27.71
Rate for Payer: Amish Plain Church Group Commercial	$27.71
Rate for Payer: BCBS Complete	$12.73
Rate for Payer: BCBS MAPPO	$22.17
Rate for Payer: BCBS Trust/PPO	$17.36
Rate for Payer: BCN Medicare Advantage	$22.17
Rate for Payer: Cash Price	$259.20
Rate for Payer: Cash Price	$259.20
Rate for Payer: Cofinity Commercial	$278.64
Rate for Payer: Cofinity Commercial	$226.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$22.17
Rate for Payer: Healthscope Commercial	$291.60
Rate for Payer: Mclaren Medicaid	$12.13
Rate for Payer: Mclaren Medicare	$22.17
Rate for Payer: Meridian Medicaid	$12.73
Rate for Payer: Meridian Wellcare - Medicare Advantage	$23.28
Rate for Payer: MI Amish Medical Board Commercial	$25.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$275.40
Rate for Payer: PACE Medicare	$21.06
Rate for Payer: PACE SWMI	$22.17
Rate for Payer: PHP Commercial	$275.40
Rate for Payer: PHP Medicare Advantage	$22.17
Rate for Payer: Priority Health Choice Medicaid	$12.13
Rate for Payer: Priority Health Cigna Priority Health	$226.80
Rate for Payer: Priority Health Medicare	$22.17
Rate for Payer: Priority Health SBD	$204.12
Rate for Payer: Railroad Medicare Medicare	$22.17
Rate for Payer: UHC All Payor (Choice/PPO)	$26.60
Rate for Payer: UHC Core	$30.68
Rate for Payer: UHC Dual Complete DSNP	$22.17
Rate for Payer: UHC Exchange	$22.17
Rate for Payer: UHC Medicare Advantage	$22.84
Rate for Payer: VA VA	$22.17

HC THIOPURINE METHYLTRANSFERASE RBC

Facility

$324.00

Service Code	CPT 82657
Hospital Charge Code	30100621
Hospital Revenue Code	301
Min. Negotiated Rate	$204.12
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna Commercial	$275.40
Rate for Payer: Aetna New Business (MI Preferred)	$210.60
Rate for Payer: Cash Price	$259.20
Rate for Payer: Cofinity Commercial	$226.80
Rate for Payer: Cofinity Commercial	$278.64
Rate for Payer: Healthscope Commercial	$291.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$275.40
Rate for Payer: PHP Commercial	$275.40
Rate for Payer: Priority Health Cigna Priority Health	$226.80
Rate for Payer: Priority Health SBD	$204.12

HC THIOPURINE METHYLTRANSFERASE T

Facility

$140.00

Service Code	CPT 82542
Hospital Charge Code	30100290
Hospital Revenue Code	301
Min. Negotiated Rate	$13.18
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna Commercial	$119.00
Rate for Payer: Aetna Medicare	$25.05
Rate for Payer: Aetna New Business (MI Preferred)	$91.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$30.11
Rate for Payer: Amish Plain Church Group Commercial	$30.11
Rate for Payer: BCBS Complete	$13.84
Rate for Payer: BCBS MAPPO	$24.09
Rate for Payer: BCBS Trust/PPO	$18.87
Rate for Payer: BCN Medicare Advantage	$24.09
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cofinity Commercial	$98.00
Rate for Payer: Cofinity Commercial	$120.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$24.09
Rate for Payer: Healthscope Commercial	$126.00
Rate for Payer: Mclaren Medicaid	$13.18
Rate for Payer: Mclaren Medicare	$24.09
Rate for Payer: Meridian Medicaid	$13.84
Rate for Payer: Meridian Wellcare - Medicare Advantage	$25.29
Rate for Payer: MI Amish Medical Board Commercial	$27.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$119.00
Rate for Payer: PACE Medicare	$22.89
Rate for Payer: PACE SWMI	$24.09
Rate for Payer: PHP Commercial	$119.00
Rate for Payer: PHP Medicare Advantage	$24.09
Rate for Payer: Priority Health Choice Medicaid	$13.18
Rate for Payer: Priority Health Cigna Priority Health	$98.00
Rate for Payer: Priority Health Medicare	$24.09
Rate for Payer: Priority Health SBD	$88.20
Rate for Payer: Railroad Medicare Medicare	$24.09
Rate for Payer: UHC All Payor (Choice/PPO)	$28.91
Rate for Payer: UHC Core	$30.68
Rate for Payer: UHC Dual Complete DSNP	$24.09
Rate for Payer: UHC Exchange	$24.09
Rate for Payer: UHC Medicare Advantage	$24.81
Rate for Payer: VA VA	$24.09

HC THIOPURINE METHYLTRANSFERASE T

Facility

$140.00

Service Code	CPT 82542
Hospital Charge Code	30100290
Hospital Revenue Code	301
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna Commercial	$119.00
Rate for Payer: Aetna New Business (MI Preferred)	$91.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cofinity Commercial	$98.00
Rate for Payer: Cofinity Commercial	$120.40
Rate for Payer: Healthscope Commercial	$126.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$119.00
Rate for Payer: PHP Commercial	$119.00
Rate for Payer: Priority Health Cigna Priority Health	$98.00
Rate for Payer: Priority Health SBD	$88.20

HC THIRD STEP GEL 8 OZ

Facility

$68.42

Hospital Charge Code	27100018
Hospital Revenue Code	271
Min. Negotiated Rate	$43.10
Max. Negotiated Rate	$61.58
Rate for Payer: Aetna Commercial	$58.16
Rate for Payer: Aetna New Business (MI Preferred)	$44.47
Rate for Payer: Cash Price	$54.74
Rate for Payer: Cofinity Commercial	$47.89
Rate for Payer: Cofinity Commercial	$58.84
Rate for Payer: Healthscope Commercial	$61.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.16
Rate for Payer: PHP Commercial	$58.16
Rate for Payer: Priority Health Cigna Priority Health	$47.89
Rate for Payer: Priority Health SBD	$43.10

HC THIRD STEP GEL 8 OZ

Facility

$68.42

Hospital Charge Code	27100018
Hospital Revenue Code	271
Min. Negotiated Rate	$27.37
Max. Negotiated Rate	$61.58
Rate for Payer: Aetna Commercial	$58.16
Rate for Payer: Aetna New Business (MI Preferred)	$44.47
Rate for Payer: BCBS Complete	$27.37
Rate for Payer: Cash Price	$54.74
Rate for Payer: Cofinity Commercial	$47.89
Rate for Payer: Cofinity Commercial	$58.84
Rate for Payer: Healthscope Commercial	$61.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.16
Rate for Payer: PHP Commercial	$58.16
Rate for Payer: Priority Health Cigna Priority Health	$47.89
Rate for Payer: Priority Health SBD	$43.10

HC THORACENTESIS/PARACENTESIS

Facility

$831.27

Hospital Charge Code	45000054
Hospital Revenue Code	450
Min. Negotiated Rate	$332.51
Max. Negotiated Rate	$748.14
Rate for Payer: Aetna Commercial	$706.58
Rate for Payer: Aetna New Business (MI Preferred)	$540.33
Rate for Payer: BCBS Complete	$332.51
Rate for Payer: Cash Price	$665.02
Rate for Payer: Cofinity Commercial	$581.89
Rate for Payer: Cofinity Commercial	$714.89
Rate for Payer: Healthscope Commercial	$748.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$706.58
Rate for Payer: PHP Commercial	$706.58
Rate for Payer: Priority Health Cigna Priority Health	$581.89
Rate for Payer: Priority Health SBD	$523.70

HC THORACENTESIS/PARACENTESIS

Facility

$831.27

Hospital Charge Code	45000054
Hospital Revenue Code	450
Min. Negotiated Rate	$523.70
Max. Negotiated Rate	$748.14
Rate for Payer: Aetna Commercial	$706.58
Rate for Payer: Aetna New Business (MI Preferred)	$540.33
Rate for Payer: Cash Price	$665.02
Rate for Payer: Cofinity Commercial	$581.89
Rate for Payer: Cofinity Commercial	$714.89
Rate for Payer: Healthscope Commercial	$748.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$706.58
Rate for Payer: PHP Commercial	$706.58
Rate for Payer: Priority Health Cigna Priority Health	$581.89
Rate for Payer: Priority Health SBD	$523.70

HC THORACENT WO TUBE

Facility

$1,088.19

Service Code	CPT 32555
Hospital Charge Code	36100383
Hospital Revenue Code	761
Min. Negotiated Rate	$685.56
Max. Negotiated Rate	$979.37
Rate for Payer: Aetna Commercial	$924.96
Rate for Payer: Aetna New Business (MI Preferred)	$707.32
Rate for Payer: Cash Price	$870.55
Rate for Payer: Cofinity Commercial	$761.73
Rate for Payer: Cofinity Commercial	$935.84
Rate for Payer: Healthscope Commercial	$979.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$924.96
Rate for Payer: PHP Commercial	$924.96
Rate for Payer: Priority Health Cigna Priority Health	$761.73
Rate for Payer: Priority Health SBD	$685.56

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